Stein calls to save Medicaid expansion after ‘Big Beautiful Bill’ is signed into law

Gov. Josh Stein said that he and the legislature will have to get creative to keep the Medicaid expansion population on the program’s rolls, now that President Donald Trump’s “One Big Beautiful Bill Act” has been signed into law. New work requirements and the provider tax cap in the bill will effectively end Medicaid expansion in the state, or create a $32 billion budget hole over the next decade.

After the Council of State meeting on Tuesday, the governor told reporters that the new federal law poses “risk” to the health care system in North Carolina. The state’s Medicaid expansion program was signed into law in 2023 after passing the North Carolina General Assembly. It added more than 650,000 able-bodies, childless, working-age adults to the federal entitlement program.

“Whether they’re on Medicaid now or they participate in the exchanges, there is a real concern about the 660,000 people who now have Medicaid through the expansion, bipartisan effort, hard work done by both parties to make sure that’s happened and as a result, people are healthier, there are many more healthcare providers in rural counties and the rural hospitals, many of which have been struggling have been solidified,” Stein, a Democrat, said. “All of that is at risk. There’s no question that the federal government is just dumping expenses onto the state, whether it’s health care or whether it’s SNAP benefits, and what we have to do as a state is make sure that we do not abandon our people the way that the federal government is abandoning our people.”

A press release issued by US Sen. Thom Tillis on June 28, after he said he wouldn’t be voting for the bill, included an eight-page report on the fiscal impact of the Senate’s proposed Medicaid policy on North Carolina.

According to data provided by the North Carolina General Assembly’s Fiscal Research Division, the North Carolina Department of Health and Human Services (NCDHHS), the North Carolina Medicaid Program, and the North Carolina Healthcare Association (NCHA), the state’s budget and hospitals would experience an estimated $32 billion impact over the next decade.

The state would be on the hook for either raising taxes to make up for the lost funding or possibly eliminating coverage for the 673,478 people currently enrolled in the state due to Medicaid expansion.

New work requirements of at least 80 hours a month, and the 3.5% provider tax cap that would eliminate all or most of the Healthcare Access and Stabilization Program (HASP), a system of state-directed payments to hospitals, will effectively end Medicaid expansion in the state.

NCDHHS officials also warned of what would happen to Medicaid expansion and the Supplemental Nutrition Assistance Program, or SNAP, on a Zoom call with reporters last week.

Stein told reporters that now that the bill has passed, the state has to be exceptionally conservative fiscally by preserving its revenue sources so that it can deal with federal funding changes for taxpayer-paid entitlement programs.

“So, we will absolutely be engaging with the leadership to encourage them to be fiscally prudent,” he said.

But Stein did tell reporters that Senate Leader Phil Berger, R-Rockingham, said that the state “will be able to adapt to whatever Congress passes,” and that he looks forward to working with the legislature to “protect the state’s people.”

Stein: Budget needs to be passed quickly to deal with pressing needs

He also called for a budget to be passed in the General Assembly, as both the House and Senate went home for a summer break before passing one for the new fiscal year.

“I think everybody needs a little bit of a break, and I do want to thank them,” Stein said. “Before they left, they passed Helene Phase 2. Those are new funds that are going to help us help people in western North Carolina get back on their feet, but we need them to quickly pass the budget. We’re in the next fiscal year. Teachers, law enforcement, and state employees. They haven’t gotten a raise.”

The governor stated that competitive salaries are important for attracting and keeping top talent in state government in departments like the Division of Motor Vehicles (DMV), especially in light of ongoing inflation. The current inflation rate as of June 11, 2025 is 2.4%, slightly above the fed’s recommended 2%, but well below 2.9% of December, 2024.

“There are real needs that DMV has,” he said. “One of the needs is that we need more people. Of course, we need process improvements and information technology improvements, but we need more people. That’s not happening because the budget has not passed.”

The post Stein calls to save Medicaid expansion after ‘Big Beautiful Bill’ is signed into law first appeared on Carolina Journal.

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